Organization
DELAWARE VISION ACADEMY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DON DAVID BLACKBURN O.D. (PRESIDENT)
(302) 998-1395
Entity
Organization
Contact information
Practice address
3105 LIMESTONE RD, SUITE 102, WILMINGTON, DE 19808-2147
(302) 998-1395
(302) 998-6784
Mailing address
212 CUNANE CIR, NEWARK, DE 19702-2074
(302) 998-1395
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
I3-0001218
DE
152WP0200X
Pediatric Optometrist
I3-0001218
DE
152WS0006X
Sports Vision Optometrist
I3-0001218
DE
152WV0400X
Vision Therapy Optometrist
Primary
I3-0001218
DE
156FX1800X
Optician
I3-0001218
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
258125
COVENTRY
DE
Enumeration date
02/22/2007
Last updated
02/27/2009
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